Issue link: https://beckershealthcare.uberflip.com/i/1534588
16 THOUGHT LEADERSHIP ASCs' cost crisis: How 'misaligned incentives' are shaping the industry By Patsy Newitt R ising healthcare costs and restrictive policies are creating significant challenges for ASCs, potentially threatening their ability to provide cost-effective, high-quality care. Joe Peluso, administrator at Aestique Surgical Center in Greensburg, Pa., joined Becker's to discuss his perspective on the policy changes needed to drive sustainability and improve patient access for ASCs. Editor's note: Responses have been lightly edited for clarity and length. Joe Peluso: Rising healthcare costs are not sustainable, since the burden is felt by patients and businesses every day through higher premiums and out-of-pocket costs. Americans are concerned about being able to pay for healthcare services and the viability of Medicare in the future. Solutions must address the misaligned incentives that are fueling cost growth. Policymakers must take action, despite lobbying and partisan politics, in at least seven areas to address some of the root causes of rising healthcare costs: We need to focus on what matters most: taking care of patient healthcare needs. 1. Ensure patients receive high-quality care delivered at the right place, at the right time, at the right price with a level payment playing field. (ASCs are reimbursed an average of 40% to 50% less compared to hospital outpatient departments.) 2. Enhance patient access to lower cost prescription drugs by the federal government negotiating lower drug prices with pharmaceutical companies, addressing the length of a drug's exclusivity period and manufacturers gaming of pricing for top- selling drugs and blocking generics and biosimilars from entering the market, in addition to the FDA providing a timely approval process for new drugs. 3. Disenfranchise integrated healthcare delivery systems that monopolize the marketplace representing a conflict of interest by being both a payer and provider network that results in gaming the system by eliminating site-neutral community healthcare competition and keeping prices high and limiting accessibility. 4. Eliminate healthcare noncompete agreements that will encourage more independent physician practices to provide patient-centric care. Seventy percent of physician practices are owned by hospitals and health systems that bill hospital outpatient rates for the same services billed at two to three times higher rates than the rate billed by an independent physician office, which also oen result in decreased quality of care. 5. Remove barriers to the appropriate use of telehealth services that will provide better patient access to underserved areas and medical specialists. 6. Address increased regulations that limit or restrict competition and cost containment tools such as barriers to interstate insurance, network management designs that restrict providers, benefit designs that restrict any willing provider. 7. Healthcare policy that provides reimbursement for pursuing community-based health and wellness initiatives coordinated across a continuum of care versus only episodic care. n Why independent practice is under pressure and what comes next By Patsy Newitt T he physician workforce is facing a period of rapid change, with independent practices under increasing pressure, alternative employment opportunities shifting and patient access to care at risk. Brian Larkin, MD, chief medical officer at Denver-based Orthopedic Centers of Colorado, joined Becker's to discuss physician workforce issues. Editor's note: This interview was edited lightly for clarity and length. Question: How do you anticipate the physician workforce changing over the next five years? Dr. Brian Larkin: I believe that the physician workforce will continue to change dramatically over the next five years. I believe we will continue to see increased utilization of advanced practice providers to support physician workforce decline. I believe that there will be continued pressure on independent practices, but the opportunities in alternative employment opportunities will start to shrink. I suspect these forces will challenge patient access to care on a regular basis. Q: With the decline of independent practices, where do you see most physicians transitioning — hospital employment, ASCs, private equity-backed groups or other settings? What factors are driving these shifts? BL: As a leader of one of the largest independent practices in Colorado, I hope we will continue to show growth in physicians. I have regular conversations about all the options that exist and am often told the same things. Hospital employment sounds great early, but ultimately is challenged over the long term by many factors the surgeon cannot control (allocation of resources, PCP referrals, potential for reimbursement to reduce). Private-equity backed groups continue to struggle with how to recruit into a group after the initial private equity investment, when future partners cannot realize the initial benefit. ASC growth will continue, but I do not believe that they will be large employers of orthopedic surgeons. Alignment with health insurance entities through MSO relationships has an opportunity to grow as well. The factors that are driving these changes are the increased cost of practicing medicine with the continued downward pressure of reimbursement. I would love to see investment into alternative payment models that reward cost containment and quality. If this were to continue to develop, I think that there would be increased opportunities for independent practices to succeed. n